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NPI Code Detail

MEDICARE: JAMIE LANDAU PA-C

MEDICARE:   JAMIE  LANDAU  PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant085007509IL

General Provider Information

NPI Number : 1134759426
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE LANDAU PA-C
Provider Business Mailing Address
First Line : 1552 N MILWAUKEE AVE APT 3D
Second Line :
City : CHICAGO
State : IL
Zip : 60622-2288
Country : US
Telephone Number : 516-304-0517
Fax Number :
Provider Business Practice Location Address
First Line : 520 W ERIE ST STE 110
Second Line :
City : CHICAGO
State : IL
Zip : 60654-5700
Country : US
Telephone Number : 312-219-2260
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2020
Last Update Date : 02/06/2020

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Directions to “ JAMIE LANDAU PA-C” Practice Location

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